title: Occult and Overt HBV Co-Infections Independently Predict Postoperative Prognosis in HCV-Associated Hepatocellular Carcinoma.
abstract: The roles of chronic hepatitis B virus (HBV) co-infection (CI) in carcinogenesis of hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC) remained controversial. To gain new insights into this issue, we investigated the postoperative prognostic value of HBVCI in HCV-associated HCC.
  
  
  
  A study cohort of 115 liver tissues obtained from the noncancerous parts of surgically removed HCV-associated HCCs were subjected to virological analysis in a tertiary care setting. Assayed factors included clinicopathological variables, tissue amounts of viral genomes, genotypic characterization of viruses, as well as the presence of overt (serum HBsAg positive) or occult (serum HBsAg negative but tissue HBV-DNA positive) HBVCI. Cox proportional hazard model was used to estimate postoperative survivals.
  
  
  
  Of the 115 patients, overt and occult HBVCIs were detected in 35 and 16 patients, respectively. Multivariate analysis revealed that tumor size >3 cm (adjusted hazard ratio (AHR), 2.079 [95% confidence interval, 1.149∼3.761]), alpha-fetoprotein >8 ng/mL (AHR, 5.976 [2.007∼17.794]) albumin <4 g/dL(AHR, 2.539 [1.399∼4.606]), ALT >50 U/L (AHR,1.086 [1.006∼1.172]), presence of occult HBVCI (AHR, 2.708 [1.317∼5.566]), and absence of overt HBVCI (AHR, 2.216 [1.15∼4.269]) were independently associated with unfavorable disease-free survival. Patients with occult HBVCI had a shorter disease-free (P = 0.002), a shorter overall survival (P = 0.026), a higher bilirubin level (P = 0.003) and a higher prevalence of precore G1896A mutation (P = 0.006) compared with those with overt HBVCI.
  
  
  
  Occult and overt HBVCI served as independent predictors for postoperative survival in HCV-associated HCC.
authors.affiliation: Liver Research Center and Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Linko, Taiwan ; Graduate Institute of Clinical Medical Sciences, Chang Gung University, College of Medicine, Linko, Taiwan.
authors.forename: Ming-Ling
authors.initials: ML
authors.lastname: Chang
authors.forename: Yu-Jr
authors.initials: YJ
authors.lastname: Lin
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Charisse
authors.initials: C
authors.lastname: Yeh
authors.forename: Tse-Ching
authors.initials: TC
authors.lastname: Chen
authors.forename: Ta-Sen
authors.initials: TS
authors.lastname: Yeh
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
authors.forename: Chau-Ting
authors.initials: CT
authors.lastname: Yeh
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery; D060085:Coinfection / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D016174:Hepacivirus; D006509:Hepatitis B / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006515:Hepatitis B virus; D006526:Hepatitis C / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate